Potential causes and treatment for this rhythm
sinus tachycardia:
Causes: Exercise, emotion, hypotension, response to acute lung or abdominal pathology, thyrotoxicosis
Treatment: usually none, in the event of thyrotoxicosis beta blockers
Potential causes and treatments for this type of rhythm
sinus bradycardia
Causes: athletes, vagotonic states: faint, sick sinus syndrome, inferior infarct
Treatment: usually none, atropine, pacemaker if symptoms
potential causes and treatments for this rhythm
first degree av block
Causes: drug induced: beta blockers, calcium blockers, digitalis; or conduction system disease
Treatment: usually benight so treatment rarely needed
Potential causes and treatments for this rhythm
third degree heart block
Causes: sever conduction system disease, rarely drugs
Treatment: pacing if ventricular rate or BP are too low
What can precede this abnormal contraction
premature atrial contraction
abnormal P wave often precedes
narrow QRS resembling normally conducting beats usually
Potential causes and treatments for this rhythm
Premature Ventricular Contractions
Cause: common in normal situations, acute MI, or heart failure
Treatment: usually not required, sometimes beta blockers used
Describe the pulse rate and quality in this rhythm and treatments
Atrial Flutter
p waves (flutter waves) rate of 240-320 beats/min
regular or irregular pulse
ventricular rates vary but usually rapid if untreated
Treatments: anticoagulation, rate control with drugs, cardioversion, ablation
What heart rate is seen in this rhythm and what treatments can be used
atrial tachycardia
heart rate >150/min (baseline = 70/min)
Treatments: adenosine, vagal maneuver, beta blocker, verapamil or diltiazem
Characteristics: narrow QRS complexes, p waves present but abnormal
Characteristics of the rhythm (depolarization rate, quality of rhythm) and patient populations this is seen in
Atrial Fibrillation
Characteristics: no p waves, chaotic atrial depolarization at >350/min (creates undulating baseline), “irregularly irregular ventricular rhythm”
Patient Populations: NI subjects (“lone a fib”), aging, post-op, heart disease, hyperthyroidism
Problems associated with this rhythm and treatments
Atrial Fibrillation
Problems: Rapid heart rate (ischemia, heart failure), loss of atrial kick ( heart failure), atrial thrombi (embolic stroke)
Treatments: anticoagulation, rate control with drugs, cardioversion, ablation
Describe the characteristis of the rhythm and comment on treatment
Junctional rhythm
Characteristics: regular, narrow QRS, no antecedant P waves
Treatment: usually not needed
Characteristics of this rhythm and treatments
ventricular tachycardia
Characteristics: usually regular, wide complexes 100-200 b/min,
usually no p waves visible, called “sustained” if > 30 sec duration
Life Threatening!
Treatment: amiodarone, lidocaine, cardioversion
